Clinical characteristics and treatment outcomes of patients undergoing nail avulsion surgery for dystrophic nails.

OBJECTIVE To evaluate the clinical characteristics and treatment outcomes of patients undergoing surgical nail avulsion. DESIGN Retrospective study. SETTING Two dermatology centres in Hong Kong. PATIENTS A total of 32 patients with nail diseases who underwent 33 nail avulsion procedures were reviewed from case records. MAIN OUTCOME MEASURES Age, gender, co-morbidities, disease duration, clinical features, histopathology and fungal culture of nail plate, nail bed specimen for fungal culture in appropriate cases, and postoperative outcome. RESULTS The mean age of the patients at the time of nail avulsion was 54 (range, 27-86) years. The most frequent preoperative findings were thickened nails (23 specimens, 70%) and discolouration (20 specimens, 61%). Onychomycosis was the most common pre-consultative diagnosis (20 specimens, 61%). Prior to nail avulsion, topical or systemic treatment had been tried in more than half of the cases. Histopathology of the avulsed nails confirmed onychomycosis in 24 (73%) of specimens. The clinical cure rate was 88% and the mycologic cure rate was 100%. The procedure was well tolerated without significant complications. Relapse was only noted in three (9%) of the patients having nail avulsions. The time for full re-growth ranged from 5 to 10 months. CONCLUSIONS Total nail avulsion is an effective management option for patients whose diagnosis of onychomycosis was doubtful, and constitutes a treatment armamentarium especially for patients with single or oligo-onychomycosis.